[Epidural anesthesia reduces mortality rate in the patients after emergency abdominal surgery].
Stress response and increased sympathetic stimulation constrict gastrointestinal blood vessels. In patients after abdominal surgery, anastomotic leakage and bacterial translocation may occur as a result of gastrointestinal hypoperfusion. These patients are at risk for severe SIRS and MOF, especially after emergency surgery. Epidural anesthesia decreases sympathetic stimulation and accordingly increases gastrointestinal blood flow. The purpose of this study was to test the hypothesis that epidural anesthesia has a beneficial effect on patients after emergency abdominal surgery. Seventy-seven patients older than 50 years of age having undergone emergency abdominal surgery were studied. Thirty-nine patients received general anesthesia alone (GA) and 38 patients received epidural anesthesia (EA). The data on APACHE II score, fluid intake and output management, mortality rate, and others of the subjects were collected from patient charts. The mortality rate 3 months after surgery in group GA (35.9%) was significantly higher than that in group EA (5.3%) (P < 0.01). There was no difference in APACHE II score and age. Fluid intake was significantly larger in group EA. To reduce mortality rate, epidural anesthesia and volume expansion are recommended for patients after emergency abdominal surgery.
Jomura
K
K
Department of Anesthesiology, Toyama Medical and Pharmaceutical University.
Hamada
T
T
Sugiki
K
K
Ito
Y
Y
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000767:Anesthesia, Epidural / Q000401:mortality*; D000768:Anesthesia, General / Q000401:mortality*; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D008875:Middle Aged; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000601:surgery